Fremont City Council Meeting: 07/11/23 07:00 PM
3300 Capitol Avenue Div/Dept: Human Services Department Fremont, CA 94538 Category: Agreements and Contracts
SCHEDULED
Sponsors:
COUNCIL STAFF REPORT (ID # 4938) DOC ID: 4938
Updated: 7/5/2023 2:37 PM by Susan Gauthier Page 1
MENTAL HEALTH SERVICES AGREEMENTS - Authorization to Contract with Alameda County Behavioral Health and La Familia to provide Mental Health Services; and Appropriate Additional Funds and Making Findings of CEQA Exemption
Contact Persons:
Name: Arquimides Caldera Suzanne Shenfil
Title: Deputy Director of Human Services Director
Div/Dept: Human Services Department Human Services Department Phone: 510-574-2056 510-574-2051
E-Mail: [email protected] [email protected]
Executive Summary: Staff recommends that the City Council authorize the City Manager to enter into two agreements not to exceed $3,120,991, including: (1) an agreement with Alameda County Behavioral Health (ACBH), in the amount of $2,853,103 for the Human Services Department’s Youth and Family Services (YFS) Division, Aging and Family Services (AFS) Division, and Family Resource Center (FRC) Division to provide mental health services and increase its capacity to provide services; and (2) an agreement with La Familia, in the amount of $267,888, for FRC Division to provide mental health counseling services, on a fee for service basis, as part of a multi-disciplinary Working Wellness Program, to adults receiving Cal WORKs benefits, who are enrolled in the Welfare to Work program and facin g mental health challenges transitioning to work.
In the Adopted FY 2023/24 Operating Budget, the City Council appropriated $2,668,898 in anticipation of these two contracts. Staff now anticipates the actual contract amounts will be $3,120,991 and therefore recommends the City Council increase the revenue estimate and appropriate an additional $452,093 to equal the revised total of the two agreements.
BACKGROUND:
ACBH Mental Health Services Contract
The Human Services department has provided Medi-Cal funded services to South County residents for many years, including mental health services, substance use disorder services and Targeted Case Management services.
Medi-Cal is California’s Medicaid health care program. This program pays for services fo r children and adults with limited income and resources. Currently, the Medi -Cal program is undergoing a transformative system change, moving away from the state funding individual services, to the California Advancing and Innovating Medi-Cal (CalAIM) program, with the goal of:
a. improving population health using a whole person care model and social determinants of health,
b. Reducing complexity and variation, and increase flexibility of services across Medi - Cal, and
Council Staff Report (ID # 4938) Meeting of July 11, 2023 Updated: 7/5/2023 2:37 PM by Susan Gauthier Page 2
c. Improving quality outcomes, reducing health disparities, and modernizing systems through value-based initiatives and payment reform.
Beginning in FY 2023/24, as part of the CalAIM program, ACBH will change the payment model for behavioral health contracts. For many years, the County provided reimbursement for EPSDT services based on the City’s actual costs up to a maximum allowed rate, which required the development of interim reimbursement rates and a final cost settlement each year. Under the new fee for service model, the City will no longer have to go through a cost settlement process and will instead be paid a negotiated rate regardless of its costs.
The YFS Division has received Medi-Cal reimbursement from ACBH for eligible mental health services since FY 1999/2000. YFS provides services to children with “full-scope Medi- Cal” (i.e., complete Medi-Cal coverage) that are funded through EPSDT, which is the joint county, state, and federal Medicaid reimbursement mechanism for services provided to children.
The AFS Division has provided mental health services to isolated seniors in their homes since 2008. This portion of the agreement is funded through Mental Health Services Act (MHSA), which was designed to expand and transform California’s county mental health services system. MHSA provides supplemental funding for mental health services through an additional one percent tax on individual taxable incomes of $1 million or more.
Shortly after the passage of MHSA, a county-wide planning process identified a need for geriatric mental health services, specifically targeted at seniors isolated in their homes and unable to access services due to transportation and physical/mental health barriers. As a result of this identified need, the City developed the Mobile Mental Health Team to provide geriatric mental health services in southern Alameda County and thereby improve the mental health of seniors 60 years of age and older, who are 1) isolated and therefore unable to access clinic services, and 2) unable to manage independence due to physical/mental disabilities. These seniors are often at risk of institutionalization, nursing home care, hospitalization, repeated 911 calls, and emergency room visits. AFS has subsequently added a Recovery & Resiliency (R&R) step-down program and a peer support program for LGBT+ older adults.
The FRC and YFS Divisions also provide Adult Outpatient Therapy services to adults with moderate to severe mental health issues. Services are provided by licensed staff, Associate Social Workers, and graduate clinical interns.
The FRC Division has collaborated with Alameda County to form a multi-disciplinary and multi-agency Family Service Team (FST) for clients with multiple issues, who are receiving public assistance through CalWORKs, since 2001. The City has provided mental health and wrap-around services, helping participants move from welfare to work.
The county re-bid these contracts for FY 2019/20 and required providers to serve a much larger geographic area of the county which included the Tri-Cities, the Tri-Valley area, Hayward, and San Leandro. Together, the City and La Familia submitted a successful application under a new program name, Working Wellness Program, with La Familia as the lead agency and the City as a subcontractor, to provide these services to an expanded south county group of CalWORKs participants.
Council Staff Report (ID # 4938) Meeting of July 11, 2023 Updated: 7/5/2023 2:37 PM by Susan Gauthier Page 3
DISCUSSION/ANALYSIS:
The YFS Division, in FY 2023/24, will provide approximately 7,669 service hours in the following categories:
• Healthy Choices School-Site Counseling Services at Fremont school sites; • The Infant Toddler Program, which serves families with children who are five years old and younger. The program includes the Early Connections project, which includes a full-time Family Partner that promotes family-driven mental health care for children;
• The Youth Service Center, which serves youth with mental health needs and their families;
• The Truancy Intervention and Probation Youth Program, which serves pre-delinquent and delinquent youth and their families; and
• Outpatient Adult Mental Health brief therapy services (the AFS and FRC divisions will provide additional support in providing these services).
In FY 2023/24, additional funding has been added to the youth EPSDT programs to cover Intensive Care Coordination (ICC) for mental health clients. This is a form of Targeted Case Management (TCM) for youth.
The AFS Division, in FY 2023/24, has added support services targeting older Asian American and Pacific Islander (AAPI) individuals. The older AAPI population has been underserved in mental health interventions. The new funds will support staff to build relationships and provide services in the AAPI population.
AFS will provide mental health services to a minimum of 70 clients a year in order to improve their ability to live safely in the community. An additional 35 clients are supported in Recovery and Resiliency program, a ‘step down’ program that offers a transition to Senior Mobile Mental Health Program clients. Together these two programs will provide 1,214 hours of outpatient services, which will include 500 hours of medication support, and an additional 396 hours of outreach and engagement. The team is multi-disciplinary, consisting of a part-time psychiatrist, part –time physicians’ assistant, licensed counselors, Human Services Specialist, and clinical supervisor. Outreach and services provision will happen in community settings, such as the Age Well Center and Senior Housing. The team also visits isolated seniors in their own homes to diagnose their mental status and assess their need for mental health services. The treatment team works with the seniors, and where possible their family, to develop a treatment plan that may include prescribing and monitoring psychotropic medications, providing counseling, and referring seniors to other resources as needed. The Mobile Mental Health team works closely with the City’s senior case management program and Adult Protective Services, and coordinates home delivered meals and inpatient hospitalization, if needed.
In addition, AFS will provide a Mental Health Peer Coaching program to LGBTQ+ seniors.
The peer model was originally developed to reduce loneliness and increase self-efficacy among older adults (at least 60+) with severe to moderate mental illness. The model had positive outcomes that improved both coaches and the peer to have emotional, mental, and physical stability with supportive environment. The peer support program was expanded to target LGBTQ+ population in FY 2016/17. The program includes process of engaging, empathetic listening, encouraging, and educating LGBTQ+ older adults around enhancing Council Staff Report (ID # 4938) Meeting of July 11, 2023 Updated: 7/5/2023 2:37 PM by Susan Gauthier Page 4
wellness and preventing isolation and reducing the stigma often experienced by LGBT+ older adults.
The FRC Division, in FY 2023/24, will continue to assist clients who are on CalWORKs in removing barriers to employment. The FRC Working Wellness program provides a coordinated and integrated system of support for clients and their families, which may include health, substance abuse and mental health services, as well as educational and job search assistance, aimed at helping them to exit the CalWORKs system. The model invites the Cal WORKs participant to be an active member of their treatment team. This program utilizes the Individual Placement and Support (IPS) model of Employment Services, provided by IPS staff from La Familia. In FY 2023/24, the FRC will provide approximately 766 hours of service to 26 unduplicated clients.
The YFS, FRC and AFS divisions will provide 976 hours of service to 35 unduplicated clients in the Adult Outpatient Therapy program, referred by ACCESS.
Additionally, ACBH has awarded HSD $88,350 in one-time funds, in response to a request for Cal-AIM capacity building funding for FY 2023/24. The majority of the funds will support office expansion at the Family Resource Center.
FISCAL IMPACT: Funding under these agreements offsets the costs of full-time mental health professionals, clinical supervision, clerical support costs and City overhead expenses.
While the reimbursement rates for the fee-for-service portions of the agreements may vary between the contracts, the total maximum amount for which the City can be reimbursed remains at $3,120,991. As part of the FY 2023/24 Operating Budget, staff anticipated these program agreements would total $2,668,898. Staff is requesting a total of $452,093 in additional appropriations in three funds to match the actual total of the two contracts.
FY 2023/24 Additional Appropriation Request
Division Fund
Current
Appropriation
Contract
Total
Additional
Appropriation
Request
AFS 104 1,026,036 1,247,611 221,575
YFS 170 1,410,634 1,517,142 106,508
ACBH One-time Cal-AIM 108 0 88,350 88,350
ACBH Contract: $2,436,670 $2,853,103 $416,433
FRC La Familia Contract: 172 $232,228 $267,888 $35,660 Totals: 2,668,898 $3,120,991 $452,093
ENVIRONMENTAL REVIEW: This action is exempt from and is not subject to review under the California Environmental Quality Act (CEQA) pursuant to, without limitation, CEQA Guidelines section 15061 and/or 15378(b)(2) and/or (5) as the activities contemplated are organizational activities of government that will not result in direct or indirect physical changes in the environment, each of the foregoing providing a separate and independent basis for CEQA exemption. .
ATTACHMENTS: None.
Council Staff Report (ID # 4938) Meeting of July 11, 2023 Updated: 7/5/2023 2:37 PM by Susan Gauthier Page 5
RECOMMENDATIONS:
1. Authorize the City Manager or designee to execute two FY 2023/24 agreements totaling $3,120,991 including:
a. an agreement with Alameda County Behavioral Health (ACBH), in the amount of $2,853,103; and
b. an agreement with LaFamilia, in the amount of $267,888
2. Appropriate an additional $221,0575 in the ACBH Aging and Family Services Fund (Fund 104), an additional $106,508 in the ACBH Youth and Family Services Fund (Fund 170), an addition $88,350 in the FRC Facilities Coordination Fund (Fun d 108), and an additional $35,660 in the ACBH FRC Behavioral Health Fund (Fund 172).